Los Rios Community College District
Student Grievance Form
(check one)
American River College
Cosumnes River College
Folsom Lake College
Sacramento City College
PART I
Date of Grievable Act:
_
(To be completed by Student Only)
Step 1. Name of Student Grievant:
Student ID#:
A.What are you grieving?
_
B What relief (or result) are you seeking?
_
_
Step 2. (Level One) Informal Meeting(s)
(Student must complete the Informal Meetings within 10 days of grievable act):
a. Date:
Met With: -------------------Result: --------------------------------
b. Date: ------- Met With:
------------------Result:
-------------------------------
c. Date: ------- Met With:
--------------------Result: -----------------------------
Student Signature:
Date:
_
(IMPORTANT to STUDENT- This form must be filed within_i days after the
conclusion of informal meeting(s) and within 25 days of the date of the grievable act.)
*************************************************************Rev.S/25/07
PART II (To be completed by Grievance Officer)
Step 3. (Level2)
Q-1 Has this student (within 10 days of grievable act) completed the Informal Process?
(Circle one) YES I NO
(IfNO, action(s) taken:
,
Q-2 Is this student's concern grievable?
(This question must be answered within 10 days from receipt of grievance.)
(Circle one) YES I NO
(IfNO, please check <Why Not?> below from <a to d> ):
a. _ Was the person a student or applicant at time of grievance or time
of action
b._ New college applicants may only grieve admission decisions
c._ Decision must have adversely affected the student/grievant or
violated their rights (See below and R 2411). Mark (x) below as
applicable:
Right to be free from censorship and advance copy
approval except as provided by district policy, statutes or
regulations.
Right to take stands on issues, examine and discuss
questions of interest, support causes by orderly means.
Right to assemble to hear speakers on any subject. On
campus student organizations can present speakers.
Right to free expression- use of designated bulletin boards,
distribution of printed materials/petitions, wearing of buttons
badges and insignia. [Students do not have the right to
engage in obscene, libelous, or slanderous expression, or
expression that creates a clear and present danger of
commission of unlawful acts on the campus.]
Right to organize around interests.
Right to be informed and participate in campus matters that
are directly relevant to them.
Right to confidentiality in their records.
Right to be free from prejudiced or capricious academic
evaluation.
Other Right
d.
_
Grades; if based on fraud, bad faith, mistake, or incompetency.
2
Step 4. (Level 3) - Notification to Person against whom grievance was filed:
a. Who: -----------------------------
Date: ------
b.
If complaint is determined to be grievable, when that determination
is made, faculty should be notified.
c.
If complaint is determined not grievable, the grievance officer will
notify the faculty member after the conclusion of the semester (or
the posting of grades) and verify that informal process was
completed.
Step 5. Grievance Hearing
a. Hearing Officer Name:
_
b. Date of Scheduled Hearing:
c. Hearing Officer's Decision (attach additional sheets if necessary):
Step 6. Timelines and Notifications
a.
Timelines may be changed by agreement.
b.
Written notices to grievant student: short, to the point, focused solely
on the question presented; include notice that any supporting
witnesses and evidence are the student's responsibility.
c.
The hearing officer's determination in Step 5 above must
include:
- Statement of Grievance
- Statement of evidence introduced by each party
- Determination whether grievant met burden of proof
- Recommendation for relief
- Must meet deadlines
d. Copies to:
D
D
D
D
Parties to Grievance
President
Vice President of Student Services
Assoc.Nice Chancellor of Student Services
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PART III
APPEALS FORM
Los Rios Community College District
American River College
Cosumnes River College
Folsom Lake College
Sacramento City College
Step 7. Level4 (This part to be completed by Student)
a. Student requests appeal:
YES
_
NO
_
b. If YES, please state your reason(s) for appeal:
OR (Mark X below) The basis of appeal is:
1. Decision is not supported by evidence.
2. Denial of admission of relevant evidence.
3. Incorrect application, refusal to apply, or interpretation of policy, regulation, law
4. Sanction is excessive.
Student Signature:
Date: -------------
********************* Do Not Write Below*********************
Step 8. (To be completed by Appeals Officer)
a. Is this appealable?
YES
_
NO
b. IfNO, why not:
_
_
c. Decision of Chief Student Services Officer (CSSO):
d. Hearing Officer (Decision) is:
D
D
Affirmed
Reversed
e. Copies I Notices to: All Parties
District Office
D
D
Whole
Part
Date: ----Date: -----
ADD NOTES/UPDATES:
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